The present invention relates generally to a new podiatric surgical procedure. More particularly, the present invention relates to an endoscopic plantar fasciotomy surgical procedure.
Heel spur syndrome, or plantar fasciitis, is one of the most common foot pathologies for which a patient will seek treatment. Heel spur syndrome occurs approximately equally in both men and women, and can effect persons of all ages. It can effect persons who are regularly active as well as those who are relatively sedentary. This condition, often described by patients as a "stone bruise" in the heel of the foot, is usually worse in the morning, or when first standing after periods of rest. As the condition worsens, the heel can hurt even when not weight-bearing.
Heel spur syndrome is usually caused by a mechanical problem involving the structural alignment of the foot. There is a dense, fibrous band of tissue in the bottom of the foot known as the plantar fascia, which is connected to the heel bone and fans out toward the ball of the foot. The plantar fascia includes a medial band, a central band and a lateral band. Because of misalignment of the foot, excessive tension is placed on this band of tissue, causing inflammation and pain where the plantar fascia connects to the heel bone.
The inflammation of the plantar fascia can cause a spur or sediment to grow adjacent the heel bone. The patient can detect the spur, or "stone bruise" in the heel of the foot, and typically assumes that it is the cause of the pain. However, it has been known for many years that the pain is actually a result of the excessive tension placed on the plantar fascia, and not because of pressure placed on the spur.
While it is possible that heel spur syndrome will subside without treatment, in most cases the longer the patient waits to seek treatment the more chronic the condition becomes. Heel spur syndrome can be successfully treated without surgery in many cases. However, if pain and discomfort are still present after nonsurgical treatment, surgery is normally recommended.
There are generally two prior surgical techniques known which are used to relieve the tension on the plantar fascia and relieve the pain of heel spur syndrome. Perhaps the most common is a procedure where the spur is removed from the foot. A large incision, several centimeters in length, is made on the inside of the heel, which allows the surgeon access to the spur and the connection of the plantar fascia to the heel bone. In removing the spur from the heel, the plantar fascia is cut and released from its connection to the heel bone. This releases the tension in the plantar fascia, thus relieving the patient's pain.
This technique has several drawbacks. First, it has long been known that the resultant pain from heel spur syndrome is not caused by the spur, but by the tension in the plantar fascia. Thus, removing the spur is an unnecessary procedure. Furthermore, the spur is a deposit formed on the heel bone itself, and surgery on the bone can be more traumatic to the patient than surgery on tissue. Additionally, because of the large incision made in the heel and the cutting of the spur from the bone, patients are usually unable to bear any weight on the heel for 2-4 weeks after the surgery. This precludes an early return to work or recreational activity.
A second known technique for relieving the symptoms of heel spur syndrome is an operation whereby the plantar fascia is released from the heel bone, thus relieving the tension on the plantar fascia. However, in this technique, a large incision is made in the heel, allowing the surgeon to view the plantar fascia and its connection to the heel bone. Making such a large incision into the heel precludes the patient from bearing any weight on the foot for 2-4 weeks.
Further, techniques which limit the patient's ability to bear weight on the heel may also minimize the effectiveness of the operation. Once the plantar fascia is released from the heel bone, the tension in the fascia releases, easing the patient's pain. Bearing weight on the foot after the operation causes the plantar fascia to fan out, into an expanded configuration. This increases the gap between the plantar fascia and the heel bone. Scar tissue will then grow to reconnect the plantar fascia to the heel bone across the gap. If the patient is able to bear weight on the foot immediately after the operation, the scar tissue will grow from the expanded state, thus creating a longer plantar fascia, which is less subject to tension. If the patient must experience several weeks of post-operative immobility, the plantar fascia remains in a contracted state. Thus, when the scar tissue grows to reconnect the plantar fascia to the heel bone, the plantar fascia may be subject to the same tension as previously experienced.
Accordingly, it is an object of the present invention is to provide a heel spur syndrome surgical procedure which minimizes the length of time necessary for patient recovery and resumption of normal activities.
Another object of the present invention is to provide a heel spur syndrome surgical procedure which reduces the tension experienced by the plantar fascia.
A further object of the present invention is to provide a heel spur syndrome surgical procedure which minimizes the cost of treating the condition.
Yet another object of the present invention is to provide a heel spur syndrome surgical procedure which minimizes the surgical trauma incident to treatment of heel spur syndrome.
A still further object of the present invention is to provide a heel spur syndrome surgical procedure which can be readily performed using commercially available equipment and conventional medical techniques.
These and other objects of the present invention are attained by the provision of an endoscopic plantar fasciotomy surgical procedure which utilizes a small incision, normally approximately 4 millimeters in length, in the heel of the patient's foot. Generally, this procedure can be performed in an office comfortably under a local anesthetic. A first incision, preferably cut in a vertical direction, approximately 4 millimeter in length, is made in the medial side of the foot. Adipose tissue is removed, and a fascial elevator is inserted into the first incision to create a channel laterally in the foot. Next, a canula and trocar are inserted into the first incision. A second incision is made on the lateral side of the foot so that the trocar and canula can substantially pierce the foot. The trocar is then removed and an endoscope is placed into the canula through the medial portal. A cutting instrument is placed into the canula from the lateral portal, and the plantar fascia is cut thereby adjacent its connection to the heel bone. To assure that a proper release of the plantar fascia has been achieved, a hook probe is inserted into the canula and moved laterally across the plantar fascia along the area where the fascia has been severed. The instruments are then removed from the canula, and the canula is removed from the foot. A bandage is placed on the foot, and the patient is usually immediately able to bear weight on the foot. In most cases, minimal, if any, pain medication is required.
Other objects, advantages and novel features of the present invention will become apparent from the following detailed description of the invention when considered in conjunction with the accompanying drawings.